Optimal pacing modes after cardiac transplantation: is synchronisation of recipient and donor atria beneficial?

Abstract

Objective-To investigate the response ofthe transplanted heart to different pacing modes and to synchronisation of the recipient and donor atria in terms of cardiac output at rest.Design-Doppler derived cardiac output measurements at three pacing rates (90/min, 110/min and 130/min) in five pacing modes: right ventricular pacing, donor atrial pacing, recipient-donor synchronous pacing, donor atrial-ventricular sequential pacing, and synchronous recipient-donor atrial-ventricular sequential pacing.Patients-l1 healthy cardiac transplant recipients with three pairs of epicardial leads inserted at transplantation.Results-Donor atrial pacing (+11% overall) and donor atrial-ventricular sequential pacing (+ 8% overall) were significantly better than right ventricular pacing (p < 0-001) at all pacing rates.

Atrial Resynchronization Following Heart Transplantation in Childhood

“…Over the past 20 years, a few investigators have explored the notion of capitalizing on the innervated and presumably normal recipient sinus node to restore chronotropic competency through atrio‐atrial triggered pacing. While conflicting results have been obtained regarding hemodynamic effects of atrial resynchronization at rest, 8–10 the ability to restore chronotropic responsiveness has yielded more uniformly positive results 1,9,11 . Two studies have addressed long‐term benefits and safety 5,9 .…”

A Comparison of VVIR and DDDR Pacing Following Cardiac Transplantation

“…Patients with persistent or symptomatic sinus node dysfunction or second-or third-degree AV block underwent pacemaker implantation 14-21 days postoperatively. The indication for pacemaker implantation in this patient group included persistent sinus bradycardia or sinus arrest (6), symptomatic sinus bradycardia [2), and thirddegree AV block (1). Pacemaker implantation occurred a mean of 14 days following cardiac transplantation (10-27 days).…”